Insights

NAHC Files Lawsuit Against CMS to Halt Pre-Claim

Posted on Friday, October 28, 2016 6:05 PM

The board of directors of the National Association for Homecare & Hospice (NAHC) is fighting against the “failed” Pre-Claim Review Demonstration (PCRD) by filing a lawsuit against the Centers for Medicare & Medicaid Services (CMS).

NAHC issued a lawsuit against CMS, which the association says “is currently ravaging our Illinois members and threatening to do the same across the country.” The lawsuit likely will be filed within weeks and will seek an injunction to stop pre-claim in Illinois, William Dombi, NAHC’s vice president for law, told Home Health Care News.

This action is to prevent pre-claim from spreading to other states. NAHC explains how this action is a “last resort,” but believes CMS has left the association “with no alternative,” according to a post on the association’s website. NAHC has filed a number of lawsuits over the years against CMS, according to Dombi.

NAHC has continuously voiced their opinions about how disruptive the demonstrations will be to the home health care industry. Agencies across the country and in Illinois have spoken out against pre-claim and their concerns over the demonstration, with one provider calling it the “worst regulation” he has ever seen.

“The Alliance and VNAA have repeatedly questioned CMS’s authority to implement the Pre-Claim Review Demonstration project,” the organizations said in a joint statement to HHCN. “We remain strongly concerned with the impact on patient access to high quality home health care.”

“One of the things that happens is that people mistake niceness for weakness,” NAHC President Val Halamandaris said at a policy briefing during the association’s annual meeting in Orlando this week. “Those of us in the home care and hospice community have always tried to lead our lives in a very high standard…sometimes they think they can kick us around. They’re wrong. They need to understand that some of the toughest people you will come across are those who have devoted their lives to caring for the sick and the dying.”

A ‘Grueling Case’To be successful, the case will have to prove that the demonstrations been harmful not only to home health care providers, but also to patients, according to Dombi, who noted that the lawsuit could be a “grueling case.”

“While we continue to seek help from Congress, the outlook for opportunities after the election led us to add the court to the forums we are using to address the reclaim issues,” Dombi told HHCN.

To involve the home health care industry, NAHC plans to lead a tour of Illinois to “publicize the damage pre-claim is doing to home care patients and providers in the state so that it can be brought to an end and not extended to anywhere else in the country,” according to the association’s website post.

CMS Stands Behind DataAlthough CMS delayed the demonstration in the other four pilot states, they do not show any signs of stopping it in the future. Additionally, CMS released data with reports on Illinois from home health agencies. The data proved to be extremely out-of-sync with high non-affirmation rates for submitted pre-claim review requests.

However, CMS explained a “wide variation in the affirm rates,” with some home health agencies receiving a 100% affirmation rate while others have had none of their claims affirmed.